These tables are based on the NIOSHr, IARCr and product information recommendations and only include drugs used in the treatment of cancer. They are intended as a guide and should not be construed as complete representation of all hazardous drugs used in health care settings.
Some drugs defined as hazardous may not pose a significant risk of direct occupational exposure because of their dosage formulation (e.g. intact medications such as coated tablets or capsules that are administered to patients without modifying the formulation). However, they may pose a risk if solid drug formulations are altered outside a ventilated cabinet (e.g. If tablets are crushed or dissolved, or if capsules are pierced or opened). The dust from uncoated tablets may present a risk of exposure by skin contact and/or inhalation when the tablets are counted.r
Reproductive hazardous drugs have a potential to be an occupational hazard to those healthcare workers (both male and female) who are actively trying to conceive and females who are pregnant, breastfeeding or may become pregnant. These healthcare workers should use precautions when handling these drugs.r
Occupational Health and Safety and Worker Compensation authoritiesrr, as well as various professional practise standardsrr, uniformly mandate the use of personal protective equipment (PPE) by healthcare workers who handle hazardous drugs. While the tables below separate drugs into the categories ‘cytotoxic’ and ‘non-cytotoxic’ there is no intention to imply that hazardous drug handling recommendations should not be applied, including the use of PPE, in either case. Due to the existence of minimal data regarding occupational risk involved in administering many agents, eviQ recommends PPE be employed unless local institutional guidelines exist that specifically address occupational risk minimisation for individual agents.
The following tables list common drugs used in the treatment of cancer classified as hazardous, or developmental and/or reproductive hazardous.
Hazardous cytotoxic drugs
NIOSH recommends full PPE when handling and administering these drugsr.
- Many of these drugs may also pose a developmental and/or reproductive risk for populations at risk.
|Dactinomycin (actinomycin D)
Hazardous non-cytotoxic drugs
For parenteral and oral liquid formulations NIOSH recommends full PPE when handling and administering. Intact drugs (such as coated tablets or capsules) may not pose the same degree of occupational exposure risk as compounded injectable drugs due to their dosage formulation. For these intact formulations NIOSH recommends single gloving for handling and administration. However, if these formulations are manipulated (crushed, dissolved etc.) they may pose a higher risk and full PPE is recommended. Healthcare workers (both male and female) who are actively trying to conceive and females who are pregnant, breastfeeding or may become pregnant should use PPE when handling all formulations of these drugs.r
- Some of these drugs may also pose a developmental and/or reproductive risk for populations at risk.
- Drugs that only meet criteria as a developmental and/or reproductive hazard are identified in the table with a blue cell colour.
|Mycobacterium bovis (Bacillus Calmette and Guerin (BCG) strain)
|Mycophenolate* (acid and mofetil)
* For parenteral and oral liquid formulations of these drugs NIOSH recommends PPE when handling and administering.
** Olaparib is not classified as cytotoxic however has cytotoxic inducing effects so is considered hazardous.r
^ NIOSH groups these agents in Group 1 i.e. recommending double gloving and a protective gown during administration. The risk of occupational exposure from prefilled syringes is difficult to quantify and no guidance provided in the literature. Whilst we have chosen to predominantly adopt the NIOSH 2016 definitions of hazardous medicines, we propose that for the administration of prefilled syringes, a more pragmatic approach may be taken permitting these agents to be administered, similarly to intact formulations.
Reproductive and/or developmental hazardous non-anti-cancer drugs
Healthcare workers (both male and female) who are actively trying to conceive and females who are pregnant, breastfeeding or may become pregnant should use full PPE when handling these drugs. Intact drugs (such as coated tablets or capsules or prefilled syringes) may not pose the same degree of occupational exposure risk as compounded injectable drugs due to their dosage formulation. For these intact formulations NIOSH recommends single gloving for handling and administration. However, if these formulations are manipulated (crushed, dissolved etc.) they may pose a higher risk and full PPE is recommended.r All other healthcare workers handling these medications should use universal precautions.
* For aerolised pentamidine a sensible approach would be to wear PPE and appropriate respiratory protection during administration.